The Investigators hypothesize that the recalcitrant nature of ocular GVHD may be related to corneal nerve damage and corneal hypoesthesia. The investigators aim to study the prevalence of corneal hypoesthesia in GVHD patients and its correlation with ocular surface changes.
Rationale: Graft-versus-host disease(GVHD) is a common complication of allogeneic bone marrow or hematopoietic stem cell transplantation (HSCT). It affects multiple systems, including skin, gastrointestinal system, liver, lung, and oral cavity, as well as eyes, which contributes to decreased quality of life and increased mortality. About 10% of patients with acute GVHD and 60-90% of those with chronic GVHD develop ocular complications. Dry eye is the most common manifestation of ocular GVHD. The pathogenesis remains unclear. The conjunctival tissue and cornea are the main immunological targets in GVHD. Patients often have punctate hypothesize that the recalcitrant nature of ocular GVHD may be related to corneal nerve damage and sensation changes. There are a few confocal microscopy studies on corneal nerve changes in GVHD, including increased tortuosity and reduced reflectivity of sub-basal nerves. However, there were very few studies on clinical correlations of those microscopic changes with corneal sensation and ocular surface health. In addition, confocal microscopes are not widely available in clinical practice. It also requires the special expertise of technicians and physicians to obtain and explain the images. It is therefore not feasible to routinely perform confocal microscopy for corneal innervation study. The investigators plan to study the corneal sensation changes and their correlation with ocular surface staining, tear film breakdown and meibomian gland dysfunction in GVHD patients. The study will shed light on an important aspect of corneal innervation damage in GVHD and may lead to new treatment modalities for those patients, noting that topical recombinant human nerve growth factor cenegermin was recently FDA approved for neurotrophic keratopathy. The investigators intend to identify the ocular characteristics of GVHD patients that may potentially benefit from cenegermin treatment.
Study Type
OBSERVATIONAL
Enrollment
30
Thorough ocular surface study including corneal sensation test in the GVHD group, comparing to the normal control group
Glick Eye Institute - Indiana University
Indianapolis, Indiana, United States
RECRUITINGCorneal Hypoesthesia
Corneal Sensation in GVHD compared to healthy age matched controls as measured with Cochet Bonet esthesiometer.
Time frame: Baseline clinic visit
dry eye questionnaire, dry eye signs, meibomian gland dysfunction
1. correlation between corneal hypoesthesia and OSDI questionaire (scale 0-100 points, where higher is worse symptoms) 2. correlation between corneal hypoesthesia and measure of tear break up time (seconds, where less is worse) 3. correlation between corneal hypoesthesia and bulbar redness (scale 0-4 where higher is worse) 4. correlation between corneal hypoesthesia and tear meniscus height (measured in mm where less than 0.2mm is worse) 5. correlation between corneal hypoesthesia and meibomiography using oculus keratograph ( lower is better) 6. correlation between corneal hypoesthesia and fluorescein staining at slit lamp (NEI scale 0-15 where higher is worse) 7. correlation between corneal hypoesthesia and lissamine green staining (NEI scale 0-8 where higher is worse) 8. correlation between corneal hypoesthesia and schirmer test without anesthesia (measured in mm at 5 minutes where fewer mm of wetting is worse)
Time frame: Baseline clinic visit
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.